Postmortem imaging as a complementary tool for the investigation of cardiac death

In the past 2 decades,modern radiological methods,such as multiple detector computed tomography (MDCT),MDCT-angiography,and cardiac magnetic resonance imaging (MRI)were introduced into postmortem practice for investigation of sudden death (SD),including cases of sudden cardiac death (SCD).In forensic cases,the underlying cause of SD is most frequently cardiovascular with coronary atherosclerotic disease as the leading cause.There are many controversies about the role of postmortem imaging in establishing the cause of death and especially the value of minimally invasive autopsy techniques.This paper discusses the state of the art for postmortem radiological evaluation of the heart compared to classical postmortem examination,especially in cases of SCD.In SCD cases,postmortem CT is helpful to estimate the heart size and to visualize haemopericardium and calcified plaques and valves,as well as to identify and locate cardiovascular devices.Angiographic methods are useful to provide a detailed view of the coronary arteries and to analyse them,especially regarding the extent and location of stenosis and obstruction.In postsurgical cases,it allows verification and documentation of the patency of stents and bypass grafts before opening the body.Postmortem MRI is used to investigate soft tissues such as the myocardium,but images are susceptible to postmortem changes and further work is necessary to increase the understanding of these radiological aspects,especially of the ischemic myocardium.In postsurgery cases,the value of postmortem imaging of the heart is reportedly for the diagnostic and documentation purposes.The implementation of new imaging methods into routine postmortem practice is challenging,as it requires not only an investment in equipment but,more importantly,investment in the expertise of interpreting the images.Once those requirements are implemented,however,they bring great advantages in investigating cases of SCD,as they allow documentation of the body,orientation of sampling for further analyses and gathering of other information that cannot be obtained by conventional autopsy such as a complete visualization of the vascular system using postmortem angiography.

Application and Prospect of Postmortem Imaging Technology in Forensic Cardiac Pathology:A Systemic Review

Postmortem imaging(PMI)technology known as virtual autopsy or virtopsy is regarded as a useful method of noninvasive or minimally invasive autopsy in forensic practice.Postmortem computed tomography is applicable to traumatic investigation,acute hemorrhage,pulmonary parenchyma disease,calcification(calculus,atherosclerosis),and gas accumulation.Postmortem magnetic resonance(PMMR)has been proven to have advantages in soft tissue identification.Cardiac death is one of the keys and difficult points in forensic practice.With the introduction and development of PMCT angiography and PMMR,it was proved to be a very promising tool in the investigation of cardiac death,including vascular cavities and ischemic myocardium.This article reviewed the applications of the latest PMI and its related technologies in forensic cardiac pathology,including advantages,limitations,and development prospects.

Comparison of Computed Tomography Imaging with Traditional Autopsy Results

The role of computed tomography(CT)images in forensic identification has been widely recognized.Such images can provide an important basis for identification of the cause of death in complicated and difficult cases,including falls from a height,drowning,explosion and gunshot cases,traffic accidents,and sudden death.However,few reports have focused on the application of CT images in cases of death caused by sharp object injuries.Therefore,the CT images and autopsy findings were compared in a case of death caused by sharp object injuries to the chest and abdomen,and the importance of CT images in cases of death from common sharp object injuries is herein discussed.

Comparison of “Normal” Craniocerebral Computed Tomography of Deceased and Living Individuals

To compare“normal”craniocerebral computed tomography(CT)of deceased and living individuals.Nineteen parameters of craniocerebral CT scans of 50 deceased and 50 living individuals that met specific filtering criteria were measured separately:The intensity(CT value)ratio of gray matter to white matter(GM/WM),maximum and minimum length of frontal horn of ventricle,transverse diameter of cerebral parenchyma,length of choroid plexus,maximum external diameter of body of lateral ventricle,maximum internal transverse diameter of cranium,length of cerebral longitudinal fissure,length between two calvarium,transverse and longitudinal diameter of the third and fourth ventricle,length of the cerebral longitudinal fissure,Hackman value,ventricular index(D/A),index of the somatic part of lateral ventricle(F/E),lateral ventricular body index(G/E),frontal horn index(G/A),and ventriculocranial ratio(VCR).The values of these 19 parameters for the deceased and living individuals were performed using statistical methods.There were significant statistic differences between deceased and living individuals in terms of eight craniocerebral CT parameters,including GM/WM,D/A,transverse diameter of the fourth ventricle,and length of the cerebral longitudinal fissure.The craniocerebral CT findings differ between deceased and living individuals.Knowledge of the normal postmortem craniocerebral CT parameters is key to correct postmortem craniocerebral radiopathological diagnosis.

Expediting the Development of Virtopsy Identification Technology in Forensic Medicine in China

Virtopsy technology is noninvasive,noncontact,and can find potential lesions.For these reasons,it has broad application prospects in forensic pathology and forensic clinical science.The present article reviews the brief history of virtopsy development,introduces the application of virtopsy in various fields of forensic medicine,summarizes the current situation regarding virtopsy in China,and puts forward suggestions for strengthening planning,setting standards,strengthening assistance,and promoting scientific research.